Schindler Christin, Schirm Andreas, Zdravkovic Vilijam, Potocnik Primoz, Jost Bernhard, Toepfer Andreas
Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
Hand und Fuss Facharztpraxis, Pestalozzistr.2, Zentrum St. Leonhard, 9000, St. Gallen, Switzerland.
BMC Musculoskelet Disord. 2021 Mar 1;22(1):234. doi: 10.1186/s12891-021-04088-w.
The aim of this retrospective monocentric study was to investigate the outcomes of surgically treated intra-articular calcaneus fractures in a maximum care trauma center.
One hundred forty patients who had undergone surgery for intra-articular calcaneal fractures between 2002 and 2013 were included. One hundred fourteen cases with 129 fractures were eligible to participate in the study of which 80 were available for a clinical and radiological follow-up. 34 patients were followed up by telephone interview only. Outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form 36 Health Status Survey (SF-36), complications, and subsequent surgeries.
Mean follow-up was 91 months (range 12-183). The overall complication rate was 29% (37/129 ft). Disturbed wound healing (11%) and infection (5%) occurred most commonly. Non-union (4%) only occurred in smokers (p = 0.02). A high rate of posttraumatic subtalar arthritis (77%) and need for subsequent subtalar fusion (18%) without independent risk factors for subsequent subtalar fusion was found. The revision rate was high (60%) after primary fusion. Mean AOFAS-hindfoot score was 74 (Sanders I: 99, Sanders II: 74, Sanders III: 77, Sanders IV: 70). The postoperative Boehler angle improved significantly in all subgroups (p < 0.01). Patients with a decreased Boehler angle between postoperative images and the follow-up had significantly lower AOFAS hindfoot scores (p < 0.01).
Our data can aid decision-making in the treatment of calcaneal fractures. We advocate to use primary subtalar fusion with caution due to the high revision rate. Smoking status should always be considered.
Level III, retrospective cohort study.
本回顾性单中心研究旨在调查在一家特级护理创伤中心接受手术治疗的关节内跟骨骨折的治疗结果。
纳入2002年至2013年间接受关节内跟骨骨折手术的140例患者。114例患者的129处骨折符合参与本研究的条件，其中80例患者可进行临床和影像学随访。34例患者仅通过电话访谈进行随访。结局指标包括美国矫形足踝协会（AOFAS）后足评分、简明健康状况调查量表（SF-36）、并发症及后续手术情况。
平均随访时间为91个月（范围12 - 183个月）。总体并发症发生率为29%（37/129处骨折）。伤口愈合不良（11%）和感染（5%）最为常见。骨不连（4%）仅发生在吸烟者中（p = 0.02）。发现创伤后距下关节炎发生率较高（77%），且在无距下关节融合独立危险因素的情况下，后续距下关节融合的需求率为18%。初次融合后的翻修率较高（60%）。AOFAS后足平均评分为74分（Sanders I型：99分，Sanders II型：74分，Sanders III型：77分，Sanders IV型：70分）。所有亚组术后Böhler角均显著改善（p < 0.01）。术后影像与随访时Böhler角减小的患者，其AOFAS后足评分显著更低（p < 0.01）。
我们的数据有助于跟骨骨折治疗的决策制定。鉴于翻修率较高，我们主张谨慎使用初次距下关节融合术。应始终考虑吸烟状况。
III级，回顾性队列研究。
